Infections

Hampshire and Isle of Wight Guidelines for Antibiotic Prescribing in the Community 2012

 

 

®Local Microbiological advice on the use of dipsticks in the diagnosis of UTI is as follows:

• Diagnosis of UTI should be based on clinical features: Do NOT use dipstick tests to diagnose UTI
• Dipsticks are generally unreliable and may only have value in women aged 16-65 with mild or inconclusive symptoms.
• Rather than using a dipstick, prescribers should obtain urine specimen and assess visually for clarity. If visually clear urine sample (comparable clarity to water) UTI excluded with 96% negative predictive value. If turbid urine sample and clinically indicated send for culture and consider delayed antibiotic prescription.

 

5.1.1.1 Penicillins

Benzylpenicillin sodium, phenoxymethylpenicillin (penicillin V)

Benzathine benzylpenicillin - NB unlicensed for GUM

Procaine penicillin - NB unlicensed for GUM

 

5.1.1.2 Penicillinase-resistant penicillins

Flucloxacillin

Consultant microbiologist only: temocillin

 

5.1.1.3 Broad-spectrum penicillins

Amoxicillin, co-amoxiclav

 

5.1.1.4 Antipseudomonal penicillins

Tazocin^® - NB: microbiology use only at RBH

 

5.1.2.1 Cephalosporins

Cefalexin, cefuroxime

For paediatrics and GUM indications only: cefixime

Cefotaxime, ceftriaxone, ceftazidime

 

5.1.2.3 Other beta-lactam antibiotics

Aztreonam

For microbiology use only: imipenem, meropenem, ertapenem

 

5.1.3 Tetracyclines

Doxycycline, oxytetracycline

For dermatology use only: lymecycline, minocycline

For microbiology use only: tigecycline

 

5.1.4 Aminoglycosides

Second line for patients with CF: tobramycin

shared care guideline for tobramycin

tobramycin (Tobi®Podhaler)

NICE TA 276 colistimethate sodium and tobramycin dry powders

 

gentamicin, neomycin

For microbiology use only: amikacin 

 

5.1.5 Macrolides

clarithromycin, erythromycin

Azithromycin - for COPD in bronchiectasis

Tobramycin (Tobi®Podhaler)

Dorset COPD treatment guideline

5.1.6 Clindamycin

Clindamycin

 

5.1.7 Some other antibacterials

For microbiology use only: Chloramphenicol (oral or IV)

Colistimethate sodium - as nebulised solution for patients with CF

shared care guideline for colomycin

Rifaximin - gastro consultant only NB unlicensed (Not at RBCH)

 

Fusidic Acid/sodium fusidate - oral formulations for skin, soft tissue or bone/joint infections

Daptomycin, linezolid

Fosfomycin -NB unlicensed

For microbiology use only: Vancomycin (oral), teicoplanin

 

5.1.8 Sulfonamides and trimethoprim

Trimethoprim, co-trimoxazole

 

5.1.9 Antituberculosis drugs

Ethambutol, isoniazid, pyrazinamide, rifampicin,

Rifater tablets (rifampicin, isoniazid and pyrazinamide)

Rifinah tablets (rifampicin and isoniazid)

 

5.1.10 Antileprotic drugs

Dapsone

 

5.1.11 Metronidazole and tinidazole

Metronidazole

 

5.1.12 Quinolones

Ciprofloxacin

Levofloxacin - oral DCH only for severe community acquired pneumonia (CAP)

Levofloxacin - iv (initial treatment) DCH only for severe community acquired pneumonia (CAP)

Moxifloxacin - PGH respiratory only, RBCH microbiology only 

For microbiology use only: norfloxacin - not at DCH

For microbiology use only: ofloxacin - not at PGH

 

 

5.1.13 Urinary-tract infections

Nitrofurantoin

 

5.2.1 Triazole antifungals

Fluconazole, itraconazole

For microbiology or haematology use only: voriconazole, posaconazole

 

5.2.2 Imidazole antifungals

Ketoconazole, miconazole oral gel

 

5.2.3 Polyene antifungals

Nystatin

For microbiology or haematology use only: amphotericin, liposomal (AmBisome®)

 

5.2.4 Echinocandin antifungals

For microbiology or haematology use only: caspofungin

 

5.2.5 Other antifungals

Flucytosine

 

5.3.1 HIV infection

Nucleoside reverse transcriptase inhibitors

Abacavir, abacavir with lamivudine, abacavir with lamivudine and zidovudine, didanosine, emtricitabine, emtricitabine with tenofovir, emtricitabine with efavirenz and tenofovir, lamivudine, lamivudine with zidovudine, stavudine, tenofovir, tenofovir with emtricitabine and rilpivirine, zidovudine

Protease inhibitors 

Atazanavir, darunavir, fosamprenavir, lopinavir with ritonavir, nelfinavir, ritonavir, saquinavir, tipranavir 

Non-nucleoside reverse transcriptase inhibitors

Efavirenz, etravirine, nevirapine, rilpivirine

Other antiretrovirals

Enfuvirtide, maraviroc, raltegravir

 

5.3.2.1 Herpes simplex and varicella-zoster infection 

Aciclovir

Famciclovir, Valaciclovir

 

5.3.2.2 Cytomegalovirus infection (CMV)

Ganciclovir, foscarnet, valganciclovir

 

5.3.3.1 Chronic hepatitis B

Adefovir dipivoxil, entecavir

 

5.3.3.2 Chronic hepatitis C

Boceprevir, telaprevir

 

5.3.4 Influenza

Amantadine, oseltamivir, zanamivir - as per NICE guidance

 

5.3.5 Respiratory syncytial virus

Palivizumab, ribavirin

 

5.4.1 Antimalarials

Chloroquine, mefloquine, proguanil, proguanil with atovaquone, quinine (oral)

Artemether with lumefantrine, primaquine, pyrimethamine with sulfadoxine

 

5.4.2 Amoebicides

Metronidazole

 

5.4.3 Trichomonacides

Metronidazole

 

5.4.4 Antigiardial drugs

Metronidazole

 

5.4.8 Drugs for pneumocystis pneuomonia

Atovaquone

Pentamidine

 

5.5.1 Drugs for threadworms

Mebendazole, piperazine